In parts 4/4.5 of this occasional series, I discussed the case at an American hospital, St Josephs in Arizona – a case which we know must have been repeated out of sight of the world media over and over again, with more tragic conclusions: of a woman who arrived at the emergency department of a Catholic hospital deathly ill from her pregnancy. (Pulmonary hypertension, in this specific instance, but there are many things that can kill a woman when her pregnancy goes wrong.)

There was a simple, obvious, and awful way to save the woman’s life: perform an abortion on a wanted pregnancy. (She was 11 weeks pregnant and there is a health center that provides abortions in Phoenix Arizona: it seems reasonable to conclude that she wanted the baby, who would have been her fifth.) The woman was told that to save her life the pregnancy would need to be terminated. She agreed to the operation. (In the first trimester, aspiration is the normal method – it’s non-surgical, can be performed with only a local anaesthetic, and would have put minimal stress on her over-taxed heart.) The operation was performed: she lived. Had the doctors refrained from performing the abortion – or had they even moved her to an operating theater – she would have died. Of course, when she died, the fetus would have died too.

My guess is that people who’ve read me on Why pro-choice is the ony moral option are surprised that I say it was an awful way to save the woman’s life. But it was: losing a wanted baby is a tragedy. To have to decide to terminate a wanted pregnancy in order to live is a very dreadful choice to have to make, and a pregnant woman has the right to choose not to have an abortion, even though the doctors tell her she would die otherwise. It’s everyone’s right to decide to die rather than receive treatment that goes against their conscience. But no one has a right to make that decision for other people. And a doctor’s overriding ethical obligation, unless they know their patient has other wishes, is to preserve good health and life.(more…)

In response to a comment on Feministe, which asserted: I don’t think any of the Catholics in question really, truly believe that if a pregnant woman’s life is in danger because of her pregnancy, she then deserves to die. That’s really kind of a ridiculous thing to say.

Well, yes, it is kind of a ridiculous thing to say – it’s both absurd and evil.

But it’s true – and not just of Catholics. There is a strand of thinking, and many of them have been arguing publicly over the last couple of days about this, that if a woman is going to die if she doesn’t have an abortion, she should die. They really, truly believe that a pregnant woman with the choice of abortion or death deserves death.

The discussion here on What’s wrong with the world illustrates this, with both Catholics and Protestants defending as a general good that idea that death is better for a pregnant woman.

But I think the reason they argue this way, positively in favor of death for the women and against life-saving abortions, is because for them death isn’t quite real – or the women who are dying.

Sister McBride probably believes quite strongly that abortion is wrong. Were we to discuss this issue in any normal circumstance, we’d probably have a massive argument. But she works in a hospital: she belongs to an order who care for the sick. For her, the decision to provide an abortion wasn’t, as it is to these religious people arguing that she should have let the woman die, a matter of airy theoretical bloodless law, but a real woman who was really dying. And faced with that reality, Sister McBride chose life.

I am absolutely certain that neither Gerard Nadal nor Bishop Olmsted has ever in his life been faced with a decision of such moral magnitude. For him, the death of a woman in pregnancy is something unreal and distant, a halo and an odor of sanctity.

“Must then a Christ die in every generation to save those that have no imagination?” Shaw asked, and the answer always seems to be, horribly, yes. But worse than that: for Nadal and his ilk, Christ must die in childbirth in front of them, before they can see they’re hammering in the nails.(more…)

This is why pro-lifers shouldn’t be allowed near hospital administration:

Last November, a 27-year-old woman was admitted to St. Joseph’s Hospital and Medical Center in Phoenix. She was 11 weeks pregnant with her fifth child, and she was gravely ill. According to a hospital document, she had “right heart failure,” and her doctors told her that if she continued with the pregnancy, her risk of mortality was “close to 100 percent.”

The patient, who was too ill to be moved to the operating room much less another hospital, agreed to an abortion. NPR

This isn’t an “ethical dilemma” even on the level of my last Pro-life is what they call themselves post: this wasn’t a situation where the pregnant woman might have been kept alive for long enough as a hosting mechanism so that the fetus could survive.

According to a professor of theology at Boston College the official church position mandates that the pregnant woman is allowed to die with her fetus, because “the Catholic perspective” is that performing an abortion is evil, and “you can’t do evil to bring about good. The end does not justify the means”.

John Ehrich, who is the medical ethics director for the Diocese of Phoenix (he now has a front-page letter on his St Thomas the Apostle parish website, from which I’m quoting), says “It is not better for a woman to have to live the rest of her existence knowing that she had her child killed because her pregnancy was high risk. When we try to control every possible situation in life, we end up playing the role of God. As people of faith we know that our lives are always in God’s hands. In these situations the reality of our dependence upon Him becomes ever more clear and pronounced.”

In short: a woman who is dying, who will live if she has an abortion, should be let die. Along with the fetus she is carrying, of course – no 11-week fetus will survive if the pregnant woman dies.

That’s pro-life theology: two deaths are better than one. That’s why no hospital should ever permit medical decisions to be made by people who will put their religious beliefs ahead of the patient.

Sister Margaret McBride is a nun of the Sisters of Mercy, founded in Ireland, “vowed to serve people who suffer from poverty, sickness and lack of education with a special concern for women and children”. Canon law mandated automatic excommunication: whether an excommunicated nun is then expelled from her Order is up to the leadership of the Order.

Sister McBride acted in the spirit of her Order’s mission:

Mercy saves lives, lifting people everywhere out of desperation and sorrow, out of hunger, impoverishment and illness.

Mercy enriches souls, bringing spirit, laughter and hope to those who thought they were lost.

Can you imagine how the family and friends of that woman whose life was saved would have felt – a friend, a wife, a mother, a daughter, a sister, taken to hospital gravely ill – and then the hospital simply puts her to bed and lets her die, even though they could have saved her?

As a matter of contrast, though acting to save a woman’s life by performing an abortion got “automatic excommunication”, ordained priests in Arizona who are known to have sexually abused children were never excommunicated.

For Michael Teta and Robert C. Trupia: the Vatican took years to examine their cases and finally have them laicized: but a 2004 report names 44 priests who served in Arizona who are credibly accused of molesting children. (YumaSun) Some may have been laicized. None were excommunicated.

Pope Benedict XVI said “Not all moral issues have the same moral weight as abortion and euthanasia. There may be legitimate diversity of opinion even among Catholics about waging war and applying the death penalty, but not however with regard to abortion and euthanasia.”

So there may be “legitimate diversity of opinion” about whether or not it’s okay to rape a child. But saving a woman’s life when her pregnancy is killing her? That’s always wrong.

The Pope says so. Bishop Olmsted of Phoenix says so. The “medical ethics” priest of Phoenix says so. Raping a child.. legitimate diversity! Performing an abortion so that one life is lost instead of two:

If a Catholic formally cooperates in the procurement of an abortion, they are automatically excommunicated by that action. The Catholic Church will continue to defend life and proclaim the evil of abortion without compromise, and must act to correct even her own members if they fail in this duty.

I have no problem with the Pope and the bishops and the priests of the Catholic Church arguing as a theological principle that it’s wrong to perform abortions. I do have a problem when their religious beliefs are allowed to make pro-life decisions in hospitals where pro-life reasoning has no place: pro-lifers may feel that two deaths are better than one, but no doctor or nurse or any other health professional ought to let that theological reasoning override their professional standards of care for their patient.

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Update: Just in case anyone was in doubt about the correct Catholic position on saving a woman’s life, there’s a post by Elizabeth Scalia, who also blogs as The Anchoress, all about how when a woman is dying and an abortion will save her life, the Catholic thing for her doctors to do is let her die – after all, if God wants her to live, God will save her. (In this kind of thinking, Catholics really don’t need to run hospitals, because if someone’s broken their leg or their appendix has burst, well, if they’re meant to live, God will save them: if they die because the leg wasn’t set or because the appendix wasn’t removed, well, God obviously wanted them dead.)

Michael Liccone’s post on the same site is almost a sideline (since the main issue for most people is the publicity about the substandard care that a Catholic hospital is required to provide by the Church’s ethical code): he points out that Bishop Olmsted sidestepped a pastoral disagreement by declaring that Sister McBride had excommnicated herself – which meant the bishop did not have to engage with the nun or pay attention to any medical evidence which would have justified the abortion according to a Catholic directive that was thought to imply that it was OK to perform an abortion if it was to save the woman’s life. (This is substandard, because it may well mean the woman will be literally at the point of death before the hospital can elect to save her: a Catholic hospital is required to be indifferent to a pregnant woman’s health and wellbeing, regardless of what long-term damage may be caused, which a secular hospital is not.)

The comments thread to the post (and to the echoed post) however makes clear that to many ardent Catholics, Bishop Olmsted’s position is the moral high ground: Catholics stand for letting pregnant woman die rather than performing an abortion. I’d say that was disturbing, but it’s also not uncommon: it’s just pro-life to let women die.

Plus this frankly amusing post by a Catholic who appears to feel that the real problem isn’t that the woman’s life was saved, but that the woman’s life was saved by a Catholic hospital – if she’d known she might die, she should obviously have gone to some other hospital where they have no moral objection to saving pregnant woman’s lives. (I agree with that, but this guy’s post is just so NIMBYish about it: why must these pesky pregnant women behave as if they thought the hospital should just act to save their lives?) (I felt slightly sorry for mocking because Nadal was very polite when I joined a discussion here, but he did acknowledge in the course of the discussion that there was a NIMBYish element to his opposition: and he presents here in detailed response to a doctor’s comments, his own settled belief that the Catholic Church’s position is that the pregnant woman should have been left to die: it was morally wrong to save her life.)